Artificial heart valves & shooting


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ctdonath
August 18, 2008, 11:06 PM
Now that I'm literally ticking like a watch, I need to know if anyone has any solid information about shooting (everything from .22LR pistol to >.308 rifle) with an artificial heart valve and/or pacemaker.

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JesseL
August 19, 2008, 12:26 AM
Sounds like a question for your doctor.

Clean97GTI
August 19, 2008, 12:35 AM
pacemakers are not bullet proof

Dgreno
August 19, 2008, 12:40 AM
Coming from someone who is actually in the medical field, TALK TO YOUR DOCTOR! You can mess some stuff up with the recoil of shotguns and higher power rifles. I know thats not what you want to hear, but keep in mind you will probably be able to shoot some. For the record, I AM NOT A DOCTOR...

kingpin008
August 19, 2008, 12:58 AM
I'm going to echo the rest of the folks here - I think the most solid information (and if I just had heart surgery done, it'd be the only advice I'd trust) is going to come from your doctor.

ctdonath
August 19, 2008, 08:51 AM
I just wondered if anyone might have anything interesting/useful to add beyond "see your doctor".

Norinco982lover
August 19, 2008, 10:16 AM
As a nursing student I have studied the human body greatly. I do not see any reason why shooting would affect your artificial heart valve. You can ask your doctor but I can almost guarantee you that he will shrug his shoulders. If he says no you shouldn't shoot I bet the next doctor would just say sure its fine if you shoot. Unless you are actually holding the buttstock of the rifle against your heart or pacemaker I don't see how the vibrations or occasional jolt to your tissues could harm you. Just keep away from the full autos and you should be fine. Call the doctor, we all want to know what he says!




p.s. not a doctor.

MMCSRET
August 19, 2008, 11:25 AM
My cousin had his done in '92, we went elk hunting in the Salmon River country the following year. As we were making our way up the mountain spaced about a hundred yards apart I could hear his valves clatter from that distance on a clear cold morning. Didn't spook that bull, it was dead on the first shot from his 99 Savage 308.

highorder
August 19, 2008, 11:35 AM
My wife is a Cardiac ICU nurse that deals with mechanical valve replacement patients frequently.

We have discussed this issue before and she said that mechanical valves are robust and should handle shock, recoil, and other bumps and jostles with few issues. However, there is a chance that the valve could seperate from the vessel wall and cause sudden cardiac trauma.

You should see your cardiologist, and seek a second opinion to confirm.

swampgator
August 19, 2008, 11:45 AM
Pacemakers are generally implanted in the weakside, because you'll lose a little use of that arm for a few weeks. That being said I did an implant on a left handed person who requested a right side device implant so he could continue to shoot.

Unless you are actually holding the buttstock of the rifle against your heart or pacemaker I don't see how the vibrations or occasional jolt to your tissues could harm you. One of the pacemaker reps that I deal with said that shooting a rifle or shotgun could cause truama to the area where the pacemaker leads connect to the device. The wires connect via a set screw in a plastic hub.

I just talked to the Cardiologist I work with, he said shooting should cause no problem to the valve once everything was healed.

OOOXOOO
August 19, 2008, 11:48 AM
My father had a mechanical heart valve put in about 8 years ago. He and I go shooting together and he has experienced no problems. We mainly shoot pistols.

Bob R
August 19, 2008, 12:27 PM
My wife's pacemaker is on her right side, just because she shoots left handed. We requested it be implanted on the right and the doc did it.

bob

ants
August 19, 2008, 01:12 PM
When you ask your cardiologist about shooting, you are likely to get a 'No' response if he/she knows nothing about shooting sports. Your doctor is there to save your life, not further your sports interests.

For perspective, the recoil from shooting a .22 is much milder than the impact from a car accident. Or a fall down the stairs. Or getting hit by a baseball. Or getting mugged in an alley. Or any number of events. Perhaps it is more important to talk to you doctor about all these things, and put shooting in a proper perspective. You'll probably get better advice.

Joe Gunns
August 19, 2008, 01:55 PM
I have pacemaker on left side since 2002. Just had it replaced in early July due to battery at "end-of-life." Shoot .375 Ruger and .45-70 from right side with no problems. Doc asked if I was shooter and if I shot right or left before original implant.

RobNDenver
August 19, 2008, 02:51 PM
What a great thread! I am going in next Tuesday to have a mechanical valve replacement and aortic repair. I told my cardiologist that I was upset that I had finally drawn an antelope buck license this year and couldn't use it. He is a hunter and says I will be fine next season. I told him I usually hunt with a 7mm Magnum and he did seem to think that would be a problem for me next year. . .

I'm telling everyone this is like having the odometer rolled back internally. . .

Claude Clay
August 19, 2008, 02:59 PM
my dad had triple bypass with a pig valve and defib unit. nothing bothered him~shooting wise anyways. you just dont want to put anything strong electrical/magnitic near the implanted unit(s) or connecting wires.

ZeSpectre
August 19, 2008, 03:22 PM
I need to know if anyone has any solid information about shooting (everything from .22LR pistol to >.308 rifle) with an artificial heart valve and/or pacemaker.

If you want to shoot, I'd use a gun not an artificial heart valve (I didn't even know they made a .308 pacemaker <grin>).

What caliber for pacemaker?

Sorry, I just couldn't resist.

XDShooter07
August 19, 2008, 03:30 PM
another intensive care nurse here. A pacemaker would be one thing because depending on what side it was on you'd be centering the recoil directly over the device. Mechanical heart valves; shouldn't be a problem. Just don't put your stock on your chest and pull the trigger; of course, that'd cause problems for everyone. But as many have said, see your physician first; specifically I would talk to the surgeon that placed the valve, he will know more about the specifics of the valve he placed than anyone.

highfive
August 19, 2008, 03:31 PM
Well I had a mitral valve replacement last year and right now my only difference in my shooting is that I wear an extra recoil pad in my shotgun and a shoulder pad, but this is just me. I go shooting when I can and like my cardiologist said you can live your life normal as long as you take good care of yourself.

PM me if you need or want to talk.... is not easy but it can be done

tpaw
August 19, 2008, 04:50 PM
The way things are today with mal-practice suits and the cover your a$$ syndrome, I can already hear the doctor saying, "well, there's always the chance that you could etc., etc., etc."

HIcarry
August 19, 2008, 06:08 PM
Talk to your doctor about it...he/she is going to be the best source of info.
That being said, many patients with prosthetic valves and pacemakers can enjoy a vigorous lifestyle, including shooting. In the early stages of your recovery you may be asked to refrain from some activities to allow the valve to "heal" into the heart, or the lead wires to adequately adhere to the heart muscle.

I did a quick search of PubMed for any info on shooting sports and pacemakers/artificial valves and could find no articles. A more exhaustive search could reveal different results.

Good luck.

lookn4varmints
August 19, 2008, 06:29 PM
One of the pacemaker reps that I deal with said that shooting a rifle or shotgun could cause truama to the area where the pacemaker leads connect to the device. The wires connect via a set screw in a plastic hub.

From someone not unfamiliar with the surgical procedure for PM placements, +1 on that comment. The connection between the lead (wire) and the device is quite robust, but who's to guess the min/max gun caliber which may cause damage.

As a side note, the lead can't be "built-in" to the device. It must have the capability to disconnect from the device because when you're due a replacement because of end-of-battery life, they typically do not replace the lead if you're not having problems. Over time, the end of the lead (the portion in your heart) becomes well-anchored in your tissue and it's best left there if an acceptable cardiac rhythm has been previously established. The ability to connect and disconnect the lead is also important for PM programming purposes during your initial placement. This lead/device connection would be the most vulnerable to gun recoil.

As previously stated, talk to your doc. If the PM location gives you problems now, it's highly likely it can be relocated later; maybe when you're due for a replacement or beforehand if it is a BIG problem.

swampgator
August 19, 2008, 07:17 PM
As a side note, the lead can't be "built-in" to the device. It must have the capability to disconnect from the device because when you're due a replacement because of end-of-battery life, they typically do not replace the lead if you're not having problems.

Not to mention that if it was a single "connected" unit, placement would require surgical implantation of the lead to the epicardium. I'm thinking a thorocotomy to implant the lead with a "tunnel" up the pacemaker pocket. Makes for a hell of a changeout.

raveneap
August 19, 2008, 08:48 PM
Last January I had an ICD implanted. (Implantable Cardioverter Defibrilator) which is a defibrilator with a pacemaker. I'd had atrial fibrilation and spent 6 days in the hospital dduring which I got zapped several times. Thankfully, they got it straightened out and my cardiologist strongly suggested an ICD. Before the procedure, I asked him about shooting and if it could be placed on the right side of my chest. (I'm left handed.) He advised that he'd much rather put it on the left as it's closer to the heart and would be a better location. (There are two small electrical leads that go from the device to the heart. I want to keep them happy! :) )End result: he advised that I shouldn't shoot rifles any more but handguns were not a problem. Well, I'm not a heavy rifle shooter, always have preferred handguns so it didn't really bother me that much. But, you know what? If the medical advice was no shooting at all, so be it. I've spent lots of years collecting my firearms and love to shoot but I'm 70 years old and would like to see many more years. There are other precautions too. I can't operate the power lawn mower or the snow blower because the pulses from the engines might reprogram or interfere with the ICD. OK. whatever he says. Again, my top priority is to be around to have priorities.

lookn4varmints
August 19, 2008, 09:30 PM
I'm 70 years old and would like to see many more years.

Sir, we hope you see many more years, too.

Fortunately, ctdonath's pacemaker situation is a little less complicated than yours (less wiring anyway), but certainly he still must be careful and he must be a compliant patient as you are. I hope he can continue to shoot his choice of firearms and I'm glad your device didn't interfere much with your hobby. I know what it's like to have a TOTAL PASSION for firearms and shooting. I'd hate to be told I must give it up. I sometimes wonder if I could give up hunting and shooting should I experience some physically-limiting medical issues that wouldn't leave me totally incapacitated. I love life, but since I have go sometime it might as well be in a tree stand or chasing coyotes. It's a bit easier to have this attitude if you're single as I am.

Both of you take care of yourselves!

lookn4varmints
August 19, 2008, 09:40 PM
Not to mention that if it was a single "connected" unit, placement would require surgical implantation of the lead to the epicardium. I'm thinking a thorocotomy to implant the lead with a "tunnel" up the pacemaker pocket. Makes for a hell of a changeout.

HA! Swampgator, you'll have to forgive me since it's been so long ago since I've been intimately involved in this stuff; about 22 years ago to be exact. I think I'm following your thoughts above, but I may just have to take your word for it at this point, brother. :D

Here's to healthy lives for all of us gun nuts!!!!!

P5 Guy
August 19, 2008, 09:45 PM
I shoot .30'06 in M1s and 03A3s, 7.62x54R and 8mm Mausers with a prosthetic mitral valve and have had no problems in the three years I've been ticking like a clock.

YK
August 19, 2008, 09:48 PM
ICDs and pacers are different. With ICD, one has to be concerned with travel of current between the lead and the can (jargon for the generator, not sound suppressor:D), so left sided placement is beneficial. With pacer, side of insertion is irrelevant.

I would not recommend positioning the buttstock over pacemaker pocket. The cans are robust, yet I wouldn't subject it to recoil if I had one, for fear of damage to it and, in your case, bleeding into pocket (see below). Hopefully, yours is on the other side.

The valve itself, however, shouldn't present any issues, at least, any that I know of. You do need to know that some valves fail at suture line and develop paravalvular leaks, at times leading to re-do surgery. I am not aware, however, of any studies linking valve failure to exposure to concussion or vibration. Usually it takes some time for stuff to heal and endothelialize inside the heart, but after that, it should be fine. I'd actually talk to your CT surgeon, not cardiologist, about healing times. I can tell you that with bioprosthetic valves we prescribe Coumadin for 3 months, assuming that after that all sutures etc. are covered with endocardial tissue.

You mentioned that it is ticking like a watch, which makes me believe it is a mechanical valve, probably St. Jude's. If that's the case, then you should be taking Coumadin. Some folks get bruised easily, and everybody bleeds easily with even small trauma. Bleeding in pacer pocket is not fun thing to have.

That's all I can think of; will post more if anything else comes to mind.

PS. You didn't say when the valve was replaced so, if it is recent, then you need to let your chest wall heal. I'd not shoot for as long as you're not allowed to drive.

lookn4varmints
August 19, 2008, 10:24 PM
Excellent post, YK! The fact that ctdonash could be a Coumadin patient didn't even dawn on me.

ctdonash, you should schedule a CYP450 2C9/VKORC1 microarray-based genetic profile immediately.....kidding, Sir!

Gotta love guns & medicine! (But not in the guns & drugs sense!)

XDShooter07
August 20, 2008, 08:41 AM
That's all I can think of; will post more if anything else comes to mind.

The more I think about it; rifles with any recoil probably aren't a good idea, besides damage to the unit itself wouldn't he be risking dislodgment of a lead; a little tickle and oh poo he's in A-fib or worse V-tach depending on his pacer. Any risk of tamponade if he pulls a lead loose or punctures one through the heart wall, maybe?

Norinco982lover
August 20, 2008, 09:48 AM
Yk hit it right on the money. I just got rid of all of my St.Jude's... (Surgical Supply Distribution Coordinator at midwest hospital)
I wouldn't worry about the recoil too much as long as you don't place the buttstock right over the pacemaker or heart valve.

YK
August 20, 2008, 01:45 PM
I asked my electrophysiologist partner about pacers today, and he have not had any issues, except for what I'd said - protection from mechanical impact. He is not aware of any issues with lead dislodgement etc. We're are in northern Utah, with plenty of hunters around here, and he said "I always allow people to hunt, after about 1 months post-implantation, and I always implant pacers on their non-shooting side".

Hope this helps, and take care of yourself.

ctdonath
August 20, 2008, 06:57 PM
Thanks for all the thoughtful & useful posts, folks.

Yes, I'm on Coumadin forever now. Any activity that risks bleeding must now be reconsidered. My knife & sword hobbies are pretty much done. (FYI to some: artificial valves require "thin blood" to prevent clots from forming and plugging the valve or causing strokes, so anti-clotting medication (aka Coumadin) is required daily forever.)

Just wanted some experienced chatter on the subject before raising it to the docs. They're mostly of the "back to normal" mindset, so I'm not too worried. Direct, traumatic chest impacts are to be avoided (Jeet Kune Do is out then), but nothing yet on shoulder impacts from rifles. Shooting enough to cause bruising is probably also not a good idea (bruising = intra-skin bleeding).

Back to my napping to recover from that feeling of being hit by a truck...

highfive
August 20, 2008, 07:29 PM
you are just making me remember that feeling...ouch.. I'm the same way I'm on Coumadin forever...and after you are healing nice you shouldn't have any problems shooting... as for me I did wait more time to fire any rifles and shotguns than I did for handguns. and like I said before I bought extra pads for when I go to the range with my shotgun, probably don't need it but hey I don't want to take any chances either....
have a speedy recovery...

lookn4varmints
August 20, 2008, 10:37 PM
I may not be telling you something you don't already know, but just in case:

If significant recoil becomes an issue, always remember there are products available for range time such as the Caldwell Lead Sled:

http://www.midwayusa.com/eproductpage.exe/showproduct?saleitemid=152664

http://i253.photobucket.com/albums/hh63/cngerms/152664.jpg

and MTM Case-Gard makes a less expensive, molded plastic version called the Shoulder-Gard Rifle Rest. I own one of these just to keep as a spare, toss-around rest in my car. It has a hollow center compartment which can be weighted down w/ boxes of ammo or bags of shot like the Lead Sled. I think I paid $20 and, yes, it does work if it's weighted down properly.

http://www.mtmcase-gard.com/products/shooting/rifle_rest.html

http://i253.photobucket.com/albums/hh63/cngerms/SGR-30.jpg

Regen
August 21, 2008, 09:32 AM
When my dad had his pacemaker put in, he told the doctor he shot trap, and the doctor moved where he place the pacemaker to make sure it would minimize the recoil forces on the pacemaker.

un_lucky
August 21, 2008, 10:23 AM
My dad had a replacement aortic valve. He shot skeet, sporting clays, trap and was an avid hunter. He also continued to work 60 to 70 hrs a week doing construction. Just make sure you stay on top of your blood thinners.

raveneap
August 21, 2008, 08:37 PM
In addition to the ICD I'm also on coumadin. Have to go to the "clinic" every 3 or 4 weeks to have the level checked. Had to give up my safety razor and get an electric. Hate it, can't seem to get a real good shave but have seen what a little scratch can do so I'm a believer. And I carry a few band aids in my wallet. And for you younger folks, don't you believe what you hear about the "Golden Years" for a minute! :)

ctdonath
August 30, 2008, 03:28 AM
Raised the issue to the doc.

Amusingly, it came up when she saw my cute baby girl, and she said "get a shotgun" (re: suitors some years hence). "Speaking of shotguns..."

Only apparent concern is to not shoot, drive, golf or fish for a couple months - gotta give my much-abused sternum a chance to heal. Avoid activities that torque the ribcage.

Beyond that, no activities that predictably result in traumatic center-chest impacts (Jeet Kune Do is over); I suppose half of the issue is the pacemaker electrodes - don't want those knocked loose somehow. Also, I figure that CCW has become more important than ever: being on blood thinners (warfarin, aka Coumadin), not getting cut is paramount in self-defense situations, so I should be equipped to stop a potentially lethal fight faster than ever.

Apparently, once everything heals, most activities are back to normal.

I'll bounce the question off another doc or two in a couple weeks, just to be sure.

Nuts: the AAC Silencer Shoot is early next month - well within my 2-month no-shooting period.

Oh, FWIW: I'm 40 and otherwise quite healthy. This stuff can sneak up on "young" guys easy. For decades I've known the valve would need replacing, but the pacemaker (side effect of degrading valve) was a surprise.

ctdonath
August 30, 2008, 04:42 AM
I would not recommend positioning the buttstock over pacemaker pocket.
Absolutely. I'm firmly right-handed, and the pacer is in the left shoulder. No problem there.

I am not aware, however, of any studies linking valve failure to exposure to concussion or vibration. Usually it takes some time for stuff to heal and endothelialize inside the heart, but after that, it should be fine.
Good. I'll pass it by the primary CT surgeon when I see him in a couple weeks. Just to be sure, I'll not shoot for the rest of the year.

You mentioned that it is ticking like a watch, which makes me believe it is a mechanical valve
Yes, it's mechanical - only realistic option considering it needs to operate for about 50 years.

You didn't say when the valve was replaced
About 3 weeks ago. Yes, I'll give it more than enough time to heal.

Blackbeard
August 30, 2008, 11:03 AM
Did they tell you to avoid any other activities when you got the valve? I had a kidney removed and they told me to avoid contact sports -- presumably because a hard jolt to my lower back could damage my sole remaining kidney.

I would think that if there is a danger to your heart from jolts or impacts they would have told you to avoid them.

rcmodel
August 30, 2008, 03:57 PM
No, but I had a Nokai cell-phone that shut itself off every time I shot a handgun with it on my belt.

Stayed on with rifles & shotguns.

Never did figure out what was up with that.

rcmodel

ctdonath
September 12, 2008, 11:05 AM
Update: three doctors so far have approved of shooting with an artificial heart valve, just wait about 3 months after the surgery. One indicated that getting shot at was probably a bad idea.

Anything that may reasonably produce a center-chest impact is contraindicated, including comments warning about downhill skiing (more aggressive styles) and motorcycles. Sparring-oriented martial arts are presumably disallowed.

Norinco982lover
September 12, 2008, 12:28 PM
Thanks for the update!

Sosa
September 12, 2008, 12:40 PM
My wife (only 30) just had her valve replaced and I can tell you that there is no better sound in the world than that nice reassuring tick tick tick. We talked to her cardiologist and the surgeon about shooting and both okay'd it after the recovery period(another 4 weeks). Since she's quite small they suggested a recoil pad for rifles to reduce any chance of bruising from recoil.

Good luck with the new ticker.

ctdonath
September 12, 2008, 01:23 PM
At a sleepless oh-dark-thirty, "reassuring" is not the term I think of about that relentless "TICK TICK TICK" that seems to emenate from the base of my skull. :-)

A co-worker heard it and said "you're ticking! no, wait, that's your watch..." Her reaction to "um, no, actually that IS me!" was delightful.

FYI tangent: if she got an On-X valve, be aware that there's a major study underway investigating the potential for a significant reduction in Coumadin.

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